The utilization of oncology web-based resources in Spanish-speaking Internet users

Spanish Adaptation and Evaluation of Clinical Discussion Guides: Communicating the External Beam Radiotherapy Experience (CEBRE) en Español

PURPOSE

Cancer is the leading cause of death for the Hispanic/Latinx United States (US) community, which comprises 64% of the US population with limited English proficiency. Despite the common use of radiation therapy for cancer treatment, there is a dearth of radiation therapy educational materials-at appropriate reading levels-available in Spanish. To address the gap in patient-centered educational resources for communicating with Spanish-speaking patients about radiation therapy, we sought to linguistically and culturally adapt the Communicating the External Beam Radiotherapy Experience (CEBRE) clinical discussion guide series into Spanish.

METHODS AND MATERIALS

From January to December 2021, we developed and applied a stepwise methodology for Spanish adaptation of the discussion guides involving (1) professional translation; (2) interprofessional review for linguistic and cultural appropriateness and medical accuracy; (3) design review; and (4) evaluation for readability, understandability, and actionability using validated tools. We applied 4 indices for readability evaluation: Gilliam-Peña-Mountain, Läsbarhetsindex, Rate Index, and the Spanish Simple Measure of Gobbledygook. Two trained reviewers assessed understandability and actionability using the Patient Education Materials Assessment Tool.

RESULTS

After 2 revision rounds, 4 CEBRE en español discussion guides were produced through an interprofessional, iterative translation and linguistic/cultural adaptation process. Readability scores across the 4 guides ranged from 4.3 to 7.3 grade-level equivalents, thereby meeting the American Medical Association's 8th-grade standard. Patient Education Materials Assessment Tool analysis yielded near-perfect scores along understandability and actionability domains.

CONCLUSIONS

The stepwise linguistic/cultural adaptation process yielded a patient-centered guide that is appropriately readable, understandable, and actionable for Spanish-speaking patients receiving radiation therapy in the US. Future work should include an external evaluation of CEBRE en español by clinicians and patients. The methodology described can be applied to adapting resources for patient-centered communication in other fields of medicine and into other languages as part of an interprofessional approach to delivering equitable health care for all.

Online health information seeking and eHealth literacy among Spanish language- dominant Latinos receiving care in a community clinic (Preprint)

Background

eHealth literacy is the ability to seek, obtain, and decipher online health information (OHI) for health and disease management. Rapid developments in eHealth (eg, health care services and online information) place increased demands on patients to have high eHealth literacy levels. Yet, greater emphasis on eHealth may disproportionately affect groups with limited eHealth literacy. Cultural background, language, and eHealth literacy are influential considerations affecting health care and information access, health care use, and successful eHealth resource use, and they may influence OHI seeking for behavioral change toward cancer prevention.

Objective

This study aimed to characterize the extent of OHI seeking and eHealth literacy among Spanish-dominant (SD) Latino adults aged 50 to 75 years. Further, we aimed to examine potential associations between sociodemographic characteristics, Preventive Health Model (PHM) constructs, OHI-seeking behaviors, and eHealth literacy, separately.

Methods

Participants (N=76) self-identified as Latino, were enrolled in a colorectal cancer (CRC) screening intervention, were aged 50 to 75 years, were at average risk for CRC, were not up to date with CRC screening, and preferred receiving health information in Spanish. We describe participants’ sociodemographic characteristics, PHM constructs, OHI-seeking behaviors, and eHealth literacy—among those seeking OHI—assessed at enrollment. Descriptive analyses were first performed for all variables. Next, primary univariate logistic analyses explored possible associations with OHI seeking. Finally, using data from those seeking OHI, exploratory univariate analyses sought possible associations with eHealth literacy.

Results

A majority (51/76, 67%) of the participants were female, 62% (47/76) reported not having graduated high school, and 41% (31/76) reported being unemployed or having an annual income of less than US $10,000. Additionally, 75% (57/76) of the participants reported not having health insurance. In total, 71% (54/76) of the participants reported not having sought OHI for themselves or others. Univariate logistic regression suggested that higher educational attainment was significantly associated with an increased likelihood of having sought OHI (odds ratio 17.4, 95% CI 2.0-150.7; P=.009). Among those seeking OHI (22/76, 29%), 27% (6/22) were at risk of having low eHealth literacy based on an eHealth Literacy Scale score of less than 26. Among OHI seekers (22/76, 29%), an examination of associations found that higher eHealth literacy was associated with greater self-efficacy for screening with the fecal immunochemical test (β=1.20, 95% CI 0.14-2.26; P=.02).

Conclusions

Most SD Latino participants had not sought OHI for themselves or others (eg, family or friends), thus potentially limiting access to beneficial online resources. Preliminary findings convey that higher eHealth literacy occurs among those with higher self-efficacy for CRC screening. Findings inform areas of focus for future larger-scale investigations, including further exploration of reasons for not seeking OHI among SD Latino adults and an in-depth look at eHealth literacy and cancer screening behaviors.

Trial Registration

ClinicalTrials.gov NCT03078361; https://clinicaltrials.gov/ct2/show/NCT03078361

Nativity and language preference as drivers of health information seeking: examining differences and trends from a U.S. population-based survey

OBJECTIVE

To examine differences in health information seeking between U.S.-born and foreign-born populations in the U.S.

DESIGN

Data from 2008 to 2014 from the Health Information National Trends Survey were used in this study (n = 15,249). Bivariate analyses, logistic regression, and predicted probabilities were used to examine health information seeking and sources of health information.

RESULTS

Findings demonstrate that 59.3% of the Hispanic foreign-born population reported looking for health information, fewer than other racial/ethnic groups in the sample. Compared with non-Hispanic White, non-Hispanic Black (OR = 0.62) and Hispanic foreign-born individuals (OR = 0.31) were the least likely to use the internet as a first source for health information. Adjustment for language preference explains much of the disparity in health information seeking between the Hispanic foreign-born population and Whites; controlling for nativity, respondents who prefer Spanish have 0.25 the odds of using the internet as a first source of health information compared to those who prefer English.

CONCLUSION

Foreign-born nativity and language preference are significant determinants of health information seeking. Further research is needed to better understand how information seeking patterns can influence health care use, and ultimately health outcomes. To best serve diverse racial and ethnic minority populations, health care systems, health care providers, and public health professionals must provide culturally competent health information resources to strengthen access and use by vulnerable populations, and to ensure that all populations are able to benefit from evolving health information sources in the digital age.

Cancer Center Website Rankings in the USA: Expanding Benchmarks and Standards for Effective Public Outreach and Education

The 68 National Cancer Institute (NCI)-designated comprehensive and cancer centers have been tasked with leading the campaign in the fight against cancer, as well as providing education and outreach to the public. Therefore, it is important for these organizations to have an effective online presence to disseminate information and engage patients. The purpose of this study was to assess both the functionality and usability of cancer centers' websites. The 68 center web domains were evaluated using two separate but complementary approaches. First, a webcrawler was used to score each website on five dimensions: accessibility, content, marketing, technology, and usability. Rankings on each dimension and an average ranking were calculated for all 68 centers. Second, a three-reader system was used to determine a list of all functionalities present on the websites. Both webcrawler scores and functionality prevalence were compared across center type. No differences were observed in webcrawler scores between comprehensive and cancer centers. Mean scores on all dimensions ranged between 5.47 and 7.09. For the functionality assessment, 64 unique functions were determined and categorized into 12 domains, with the average center possessing less than 50 % of the functions. This census assessment of NCI centers' websites suggests the need for improvement to capitalize on new dissemination platforms available online. Progress in development of this technology can help achieve the goals of public education and outreach to a broad audience. This paper presents performance guidelines evaluated against best-demonstrated practice to facilitate social media use improvement.

Use of Survivorship Care Plans and Analysis of Patient-Reported Outcomes in Multinational Patients With Lung Cancer

PURPOSE

Lung cancer is the leading cause of cancer death and is a significant source of morbidity. Patient-reported outcomes (PROs) have been shown to be prognostic for survival. We have analyzed emerging patterns of longitudinal PROs collected in the development of survivorship care plans (SCPs).

METHODS

OncoLife and the LIVESTRONG Care Plans are Internet-based programs designed to generate unique SCPs. We selected SCPs from patients identifying as survivors of primary lung cancer. Patient-reported demographics and treatment and toxicity data were examined. Effects were categorized by the physiologic system that they affected.

RESULTS

Six hundred eighty-nine plans were created for users self-identifying as survivors of primary lung cancer. Average time from diagnosis to reporting was 1.68 years (range, 0 to 24 years). Most were white (85.9%), well educated (61.1% "some college" or higher), and lived in the United States (90.7%). Patients underwent chemotherapy (75.8%), radiotherapy (54.7%), and surgery (54.4%). Neurocognitive symptoms (eg, fatigue, cognitive changes) were the most common (48.8%), especially among those receiving chemotherapy, followed by musculoskeletal/dermatologic symptoms (14.1%) and thoracic symptoms (13.5%). Only 11.2% were initially offered an SCP. Of those offered SCPs, 54.5% were offered by their health care provider, and most often were at a non-university-based cancer center (66.2%).

CONCLUSION

For patients with lung cancer worldwide, it is feasible to obtain PROs and to create SCPs through an Internet-based program. As patients with lung cancer achieve improved survival, further attention should be paid to PROs. Surprisingly, neurocognitive symptoms seem to be the most common issues and therefore the most important to address. Increased effort should be made to provide SCPs, particularly in urban and university cancer center settings.

Media and Technology Use Among Hispanics/Latinos in New York: Implications for Health Communication Programs

OBJECTIVES

There is limited information about media and technology use, as well as health information-seeking patterns, specifically for Hispanics/Latinos at the state level. An understanding of access, usage patterns, and preferences for receiving health information is critical for state-level organizations to effectively reach and serve this growing population.

DESIGN

A telephone survey was developed to assess media and technology access, use patterns, health-seeking information patterns, and preferences for receiving health information. The survey was conducted in New York state from August 8 to November 4, 2013, using random digit dialing. The overall sample of 1350 included 412 Hispanic/Latino adults who are the focus of this study.

RESULTS

Most Hispanic/Latino respondents reported having at least one working computer at home (78 %) and using the Internet (84 %); almost all who had a computer reported having high-speed Internet service (90 %). Cell phone ownership was common (88 %), and many had a smartphone (71 %). Activities most likely to occur several times per day were sending text messages (61 %), using phone apps (49 %), using a search engine (40 %), using email (34 %), and using social networking sites (32 %). The most preferred channels of receiving health information were websites, mail, and television. Older respondents were significantly less likely to have the technologies, engage in technology activities, and prefer newer forms of information dissemination (i.e., text messages). Education and income were important predictors in some cases.

CONCLUSIONS

While most Hispanics/Latinos have access to various technologies, the reason for using those technologies and preferences for receiving health information most often varies by age and, sometimes, by education and income. Older adults tend to seek health information from traditional sources such as television and brochures, while younger adults favored newer technologies. Knowing preferences of the population can help ensure proper media channels are selected for dissemination of health information to Hispanic/Latino communities.